This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Thursday, 30 September 2010

Quote from a Newly Qualified Nurse

Found this quote on the Nursing article linked on the post below.

I am a newly qualified nurse working as an auxiliary on the bank when I am lucky enough to get shifts, there has been so much red tape to stop newly qualified nurses from getting a job in the NHS. It is very disheartening to go through all the studying and work to have nothing in the end. I am now looking to go in a new career direction as I need paid employment and that is not something I can find as a nurse sadly. When will they realise they need frontline staff and this is not something they can cut?

I keep hearing this over and over again from new Nurses. Over and over again.

How can people blame university (new) training for Nurses for the hellish conditions on the wards when our new RNs cannot even find jobs? The vast majority of Registered Nurses practicing in the NHS trained under the old system and they are on their knees due to the lack of RNs. We need RNs and we need new blood to replace an aging workforce. What we don't need are more untrained unskilled minimum wage earning ward assistants. But that seems to be all that we are getting.

31 comments:

Seems to be happening every year. Students that we had at Easter were already aware that there would only be a very small percentage who would be able to get jobs locally. Now I know that many people will pull out the "relocation" argument...and yes, for many jobs you do have to be prepared to relocate. What I don't understand however, is if all teaching hospitals are unable to offer more than a handful of jobs (and by and large these are the biggest hospitals) whats going on? I look around my own trust and see that most wards are understaffed (trained and untrained alike) yet we have a job freeze. The local private hospitals do not take on newly qualified nurses due to the old "preceptorship" card. Lets face it, that leaves nursing homes...now I have nothing against nursing homes...however, for a NQ staff nurse, how can they be expected to get their skill base up to scratch? One of my friends who took a career break ended up spending 3 years working in a nursing home (she is an ED nurse) and evey time she applied for an ED job, she was told that she needed to get "acute" experience. In the end she took a job in a private hospital on an elective cardiac ward. This is a nurse with 10 years experience who had only taken a year off ( so PIN was ok). Now I know the long term plan is to (1) privatise the NHS and (2) promote homecare but really....( and BTW politicos, homecare is not the cheaper option if it is done correctly...that is using RNs rather than HCAs and providing a round-the-clock service.) So yet again we will get a half-cocked attempt to do it on the cheap, next step will be to reduce training places I guess. Might as well hand out greencards to NQ nurses along with their degrees and put them on the plane to the US/Canada/Oz.

I've worked in Boston and Virginia and enjoyed both. I was able to have a decent standard of living, a short commute and not be run ragged due to lack of trained RNs. I have friends who have also worked in Canada and US and all rated Canada as a better place to live/work. If I were younger then I think I would be heading to Canada.

I've been reading your blog for a while now, Anne. I'm in a different profession and healthy, thank goodness, so as a citizen who luckily has a very rare need for doctors or nurses, I am appalled to read about ward assistants. It's not something I could have imagined happening and I am sure that 'most of the ordinary public' doesn't know about it either.Keep up the good work!

This should be publicised widely + what is the RCN's Peter Carter doing about this state of affairs? They have all the means necessary to investigate + draw the public's attention to the sorry state of the nursing profession. And NO qualified RN should be working as an auxillary. Did Christine ever respond to your invitation Anne ? How did it come to this ? Anna

having had sodium docusate and senna poured down his ng tube for 6 days. Mr Roger Mee developed type 7 diarrhoea. Oh we MUST DO a diarrhoea form said Nursey, OOH did you also fill in a stool charge said sister? has matron been told? does infection control know? did the domestices up the cleaning? lets put in a flexitube! Roger Mee said nothing, no one heard his silent screams since the cuff of his trachy was up. then they hoisted him to a chair and he could feel the poo seap around the tubing. Capgrass was called to change the curtains and do extra cleaning. Cagrass is in constant pain following a severe beating she once recieved years ago in Ruwanda. however she needs this job so she bent down and wiped under the bed. she cleaned: and was watched by 2 infection control sisters, and 2 nurses. all of whome ticked a box on a chart. Capgrass got her revenge though, instead of wiping down the thilthy nurses coffee table in the office. she locked herself in the cleaning cupboard, rolled her self in blanket and had an after lunch siesta.

Funny as always, Capgrass...and oh so close to the truth :0DI have lost track of the numbers of times we have had patients on MAU with poo problems who IF nurses are demanding we isolate...we have NO siderooms on MAU as they had to be turned into treatment rooms and storage. There is no reasoning with them...they are totally blinkered by c.diff- of course nothing else can cause diarrhoea afterall. We have had several patients on ICU that have been isloated, had all the treatments (including a GI scope) and ALL have been inconclusive and c.diff negative weeks beforehand but no, they then need to be transferred to a sideromm on the ward. The consultants will no longer speak to some of them and leave us to take the (c)rap.

NHS jobs has becoem my new best friend Anne. I am due to qualify in April and have started looking at jobs, applying for one in a neighbouring city on the rationale that if I were to get it I'll work bank over the next 6 months like a man possessed and buy a car and commute, I spend a n hour on the bus every day to get to my hospital anyway so whats the difference if I'm driving instead?

I really do not want to be left working as a band 2 in April but, bills need to get paid. I know I'm not the only student who is in this situation or is worried about it. There is no way I wil take employment in a nursing home, I have no interest for it what so ever. I cal relocate within reason, but my partner is also doing her training so need to be able to be somewhere where she can get a job too. The RCN is running a campaign called frontline first about jobs that are being cut, I will be interested to see if they use this information gathering exercise for anything at all.

Matt, I think it is great that you are job hunting early. I regret having not done this myself as I qualified in July this year and only started looking at jobs in May.

I unfortunately qualified late due to failing my dissertation first time around. Most of my cohort secured jobs back in Dec 09, so I stupidly assumed I would just walk into a job.

Because of recruitment freezes this year, it has been incredibly difficult. I have applied to several hospital posts (not all local) and have not heard anything.

Rang a ward manager the other day regarding a post and was told that there are a large number of applicants and that she would rather take an experienced nurse so she does not have to invest in preceptorship (nothing like honesty)!

My advise would be to work really hard on your final placement and suck up to the ward manager. These are the students who get jobs lol!

It’s a long post...Is that OK?Having read this string and another one from 21/02/10 about St/N’s I thought I’d leave my first post.....I’m in my final year of degree (gasp!) training and yesterday came off my 2nd non-official long day shift in a row, following my 4 official ones. The ward that I’m on placement on is so desperately busy and so badly understaffed at the moment that I’ve gone into ‘work’ on 2 of my 3 days off to just try and help pick up the slack a wee bit. Now, I’m not asking for any congratulatory words; I’m not getting paid anyway and the longer I spend there the more ‘nursey’ type stuff I’m likely to learn (although probably by a process of spongelike absorption rather than actually ‘being taught’). I’ve basically been a HCA for the last 2 shifts because I’m not there officially as a St/N and can’t put the hours on my university timesheet because questions will be asked and the knackered RN’s and I will get ‘talked to’ by my uni’s placement development team. But if I wasn’t there the 2 people who nearly fell out of bed yesterday may have not been caught, the phone which rang constantly for 13hours would never have been answered (God forbid a clerk should work a Saturday) and maybe the elderly lady who couldn’t reach her dinner would have gone hungry.At the end of the day I’ve been there, working myself into a sweat (good job I’m sweating really as there was no wee break yesterday!) with a meltdown just around the corner......and some flippin numpty from a different uni who is also on placement there has the audacity to tell me that she’ll be a better nurse than me in a year because my degree course is too academic focussed whereas her diploma has given her nursing skills which will serve her better in future. The worst part of this was that she said it to me at 6hours and 58minutes into her official 7 hour shift whilst putting her coat on to go home and I was rushing past her with another full commode pot and another 3 hours to go before coat time. I am still at a loss as to where the Diploma v Degree debate began but I can see that it has got to the stage that even the St/N’s have been poisoned by it.I appreciate that many of you will feel that I’m setting myself up for a very hard fall and to be thoroughly taken advantage of but I’ve seen so many RN’s stay for an extra hour or 2 after their shift to pick up slack or finish paperwork that I think maybe real work will come as less of a shock to me and my husband than it will to my fellow St/N and hers.......if we can get jobs? I’m so sorry to be ranting on.......

Degree courses for nursing in the UK have been around since at least the 1980s. Initially they were in the minority with only a few universities offering them and then only a few places each year. I'm not sure where the animosity came from...I can remember being told as an RN that I would be redundant when P2K came in ( it came and went and I'm still here). I think alot of it is from outside the profession...degree heavy professions can demand more money because the theory is you can take your degree and go and do something else ( I have several degree educated nurse friends who are now teachers and accountants, for example). I think people also think that a degree educated workforce will be more likely to demand better working conditions? There is also a degree (pardon the pun) of snobbery...people still think that nurses are nice but dim and if the course is a degree based one then alot will be "put off"....that kind of thinking is never directed against other HCP such as physios, OTs, radiographers. I have lost track of how many times this has been said in the press...well I'm sorry, nursing in the 21st century will require degree educated folk- its a long way removed from the days of Florence Nightingale (and if you believe the hype she was pretty interested in science herself). My bug bear is that the UK degree seems to be a bit wishy washy...not enough science and way too much psychobabble (unlike the US courses).

As far as I am aware the degree students in the UK have the same amount of clinical placement time on the wards as the diploma students. Where I trained (overseas) the degree student nurses have more ward placment hours than associate and diploma students because the degree course in longer.

In short, you are awesome. Don't listen to that idiot who doesn't understand the difference between a degree and diploma nurse. She is probably just developing a pre-emptive chip on her shoulder because she erroneously believes that you will have a superiority complex.

When you both qualify you will both be doing the same job (NMC registered staff nurse) for the same pay. Your degree just gives you some higher level thinking that allows you to assess your patients better and pull that together with everything that is being done for the patient.

Dino is right. The US nursing program is more science based. My school was very competitive and we had to take university level chemistry, microbiology, and anatomoy and get great grades in those classes to be considered for entry into the nursing program. Also had to be in the top 10% of our high school class.

This was to enter a nursing program that would qualify us as direct care providing registered nurses, not mini doctors.

And still it was very competitive. Many many nurse wannabes did not get in and would have to try again next year. There are many more people who want to be Nurses than their are training places.

Dino is right about the fact that the UK nursing program (both degree and diploma) has a lot of pyschobabble and not enough science. But don't worry about that.

What I can't understand is why the public and people like old Dr. Crippen think that degree educated nurses are not for the bedside.

Be careful about the extra shifts. IF the shit hits the fan they will try and flog it onto you for being there when you are not supposed to. No one will ever thank you for working 12 hours without stopping unpaid.

I stayed and did a double shift (16 hours) last week unpaid because we are so short staffed.

After I finally handed over to night shift I sat down with a coffee for the first time in 16 hours. As I was finally off duty and had given my patients to an oncoming nurses I wanted to go home but I had to finish some legally required paperwork.

A patient walks by and goes "there are call bells ringing can't you get up off your ass and do something about it".

I guess the public just expects us to stay there 24/7 without pay. There are always going to be more bells ringing and more patients needing help then the nurses on and off duty can attend too. Always.

I was off duty at this point and so exhausted I didn't think I was going to be able to drive home.

I nearly told him that "at least we are not like you lazy pieces of shit who only work 8 hour days with a lunchbreak and would be out on strike if you had to stay at work 16 hours unpaid, you fucking pansy. If we were like you worthless pieces of fuck who work outside of healthcare the NHS would have crashed and burned long ago"

Bambi, as Anne has said, I would be really careful about dong extra hours, as if you are not there as a HCA employed by the trust but are there outside of your placement hours and something goes wrong you will not have a leg to stand on. I know what you mean about saying, if you were not there that peoples care may suffer, but burning yourself out is not the answer. As students we have the opportunity as being on the "outside looking in" on a placement area, where we can say something to staff at the uni, staff at the trust and so on and there is a chance it will be listened to. That ward area is also taking the piss out of you, allowing you to come in and be a free HCA for them. The NHS will keep taking as others have said before but give fuck all back.

As for the dipHE student, I'm a diploma student and I would have tore her to pieces for what she said, she clearly has no idea what is actually involved in nurse education and has brought into the rumours that people like to spin in the whole degree versus dipHE debate.

Thank you all for your posts - I think I appreciate a bit better now the degree / diploma thing - perhaps in my naivety I thought that all nursing students who undertake 3 years of training and start at the lowest 'Staff Nurse' grade would see each other as the same in ability and drive. I wondered after my post yesterday if perhaps the other St/N on my ward has just had a placement or a mentor who had a problem with degree nurses and that's rubbed off? Anyway, never mind! On a bonus note I got into work this morning and my mentor gave me a packet of chocolate hob nobs and told me to go home, put the last 2 shifts on my time sheet, and take an extra 2 days off this week! Which is why I'm sitting here about to tackle an 'Ethics and the Law in Nursing' assignment. I know it's cruel but I felt fab walking off the ward again at 8am with the night shift girls watching the other student run off to a call bell (I'm such a cow!) Thanks again to you for listening to my inane drivel yesterday!

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.